It's hard to argue with success. Stories of weight loss, or the promise of weight loss, seem to be everywhere you look. Jared Fogle's 235-pound weight loss thanks to Subway inspired a new diet trend; a slimmer Sarah Ferguson has lent her royalty promoting Weight Watchers.

These people echo the positive and self-affirming qualities of losing weight that have been documented by everyone from doctors to advertising executives to close friends and family. But losing the weight doesn't always produce carefree people for whom size 26 dresses or pants with a 58-inch waist are distant memories. For some, losing weight doesn't solve any emotional problems. It canintroduce more of them as they reevaluate their relationships with strangers, loved ones and, most importantly, themselves.

Yael Gold, a local therapist focusing on eating disorders, said people who once were morbidly obese have contended with self-esteem and worthiness issues for years, and the bad feelings don't fade away with the pounds. Dr. Gold said the weight can act like an emotional buffer; should weight be lost too quickly, longstanding emotional issues or past trauma can intensify. Often, new problems are introduced faster than the newly slimmed person can process. Among the issues they are dealing with are new tension in relationships, refusing to accept themselves as thin, resenting the new attention that was never given to them before or realizing the degree to which the weight was a shield from sexual advances. "The internal identity does not change right along with the external body, and that's probably why there are so many issues to deal with," Dr. Gold said.

Patty Lyons and Lorie Alford have experienced the identity issues that accompany weight loss. Both underwent gastric bypass - an operation that reduces the size of the stomach - within the past three years. Each lost a significant amount of weight and had additional surgery to remove the excess skin from their stomachs. Relaxed and informal, the pair exudes enthusiasm. They are grateful for the energy and improved health the surgery has given them. The novelty of everyday actions that go unnoticed by most people - adjusting the car seat up and crossing their legs - thrill them as they couldn't do them before. They rack up shoes and revel in buying clothing that aren't in a "plus size" section or store. But they said making the transition from overweight to thin was and continues to be a rocky one. The increased positive attention they receive from strangers - or at least not looks of disgust or pity - are one of the things that have made the surgery rewarding for them, but it has also bred resentment. While now they're commonplace occurrences, at one time, Mrs. Alford couldn't get help from a store clerk and seldom had someone open a door for her. Mrs. Alford said that the public's behavior is flattering and frustrating, as it illustrates the prejudice people held against her and obese people in general. "It's not the surgery that changed us, it's Johnny Q. Public's reaction to us that has changed, and we have changed in response to that," she said. And while Mrs. Lyons said she deals with similar situations daily, she balances her resentment with appreciation. "On the other hand, it's awesome to have people look at you in a way they haven't before." But sometimes they said they get anxious, thinking that any passing giggle or snicker they hear in public is about them. Conflicting emotions in relationships with spouses or family aren't any easier to balance. Paul DeConna, a psychotherapist who works with obese patients, said old relationships with family and spouses can be strained and jealousies may arise. He added that forging new relationships can be difficult, as people who have been obese since childhood often don't learn ways of dealing with sexual attention because they had little experience with it. Mrs. Lyons now deals with unwanted suitors coming her way, and she said it's new territory for her and her husband. She is beginning marital counseling more than a year after her operation to help ease the jealously issues that have come with the 149-pound weight loss. "It's like when somebody's attracted to me, I ask them 'Would you have done this before when I was fat?'" she said. "I usually didn't get an answer, sometimes I did, but I usually didn't." Mrs. Alford married her husband 18 years ago and knew him for six years before their marriage. She said he was a constant source of support before the surgery. These days, though, he also is uncomfortable with some of the attention she is getting after her loss of 220 pounds. Before the surgery, Mrs. Alford left home only when necessary; now, she likes to go dancing and meet her friends who also completed the procedure. She said her and her husband continue to work through the feelings that have emerged and hope to find some stability in their relationship again. "It's been an up-and-down roller coaster. He's as confused as we are in a lot of ways,"

Mrs. Alford said. "We always wonder: Will it just ever be the status quo again? And I don't know." Both Mrs. Alford and Mrs. Lyons' families have pushed them to lose weight for most of their lives, to the point that Mrs. Lyons said she was once forced to eat brussel sprouts until she vomited. Now that's she's thin and some of her relatives are becoming obese for the first time, she said the change is awkward. "Since I lost my weight, my sister has ballooned. I did not recognize her." Mrs. Lyons said. "I was proud that I was the thin one now." Dr. Gold said that while genetic evidence exists as a cause of obesity, often there is a reason that the weight exists. Mrs. Alford believes the weight, in some ways, kept her safe. "I think for a lot of people ... it's a safety net," she said. "(Me and other gastric bypass patients) discussed this a lot and discovered that a lot of times - not always - there's a common thread of sexual abuse and molestation, and they consciously or sub- consciously pack the weight on to defend themselves." A survivor of both molestation and rape, Mrs. Alford sees the relationship between her past and her weight but refuses to dwell on it. "I'm a real strong-willed person," she said. "I don't say I was traumatized by it in the way it is depicted in the movies. It's something that I almost forget about, and then it creeps up on me. I think (the weight) was more of a cocoon, and I tried to insulate myself." With all the issues that the pair faced after their weight loss, Mrs. Lyons and Mrs. Alford find support in each other, mutual friends who also had gastric bypass and support groups to help them readjust their lives with the issues they now face. While neither sought therapy immediately after the surgery for insurance reasons, they said their operations would not have been successful without support. To help address the identity issues that come with losing weight, some are coupling therapy with their weight loss methods. Ronda Dixon of Holden Beach knew that shrinking her body size didn't mean she was changing her emotions and thoughts, so when she began to lose weight again last January, she tried a different approach. "I knew there was more to it than just liking to eat and being excessive," Mrs. Dixon said. "I wanted to do whatever it takes to keep this weight off me. And I found it to be true that treating my mind was more important than treating my body." She turned to Weight Watchers, a program she used various times before with temporary success. This time she augmented the program by seeing a therapist for the first time. The effort paid off, and she lost 105 pounds in one year. Mrs. Dixon said that through therapy, she learned to become calmer and less inclined to appease others at the expense of herself. She now is employed by Weight Watchers in Holden Beach and is helping others reach their goals and deal with their emotions. While she doesn't recommend therapy to her clients at Weight Watchers, she said that taking the time to examine her behavior through counseling was the her key to losing weight. "I think (overlooking the psychological aspect) is one of the biggest errors people who are losing weight make," Mrs. Dixon said. "I don't think they ever get to the issues. Most people don't actually try to understand why they do what they do in the first place." Dr. DeConna said that without examining the psychological causes of obesity, problems can reoccur and can lead to someone sabotaging their own attempts to become healthier. "They had issues that cause obesity. But those issues remain (after the weight loss), and they have to deal with them," he said. "Without the insight, you don't recognize that losing weight isn't the sole answer." And with the support she offers and receives, Mrs. Dixon feels that this time, her excess weight is gone for good. She hopes to be finally - and permanently - one of the success stories. "I honestly feel for the first time in my life that I have a shot at keeping this weight off, and to me that's a beautiful thing."